Patient Forms

Our Forms

What You May Need

Release of Records

Complete this form if you have records and/or X-Ray films at another office that you’d like sent to us.

Injured in an Auto Accident?

Complete this form if you were injured in a motor vehicle accident.

New Patient Packet

Contains Patient Registration, Current Condition Form, Patient History Form, HIPAA, Financial Policy, and Terms of Acceptance. Open in Adobe Reader or Acrobat for fill-able form fields.

Insurance Assignment

This form is for when you want us to bill insurance or a party other than yourself.

Injured at Work?

Complete this form if you were injured at work.

Opening an LNI Claim?

Get more information here:

You can also start your claim by filling out a Report of Accident here:

Don’t worry, you can also fill it out on paper in our office, if that is your preference. If you open a claim online – don’t forget to let us know!

We are here to help you

Chiropractic Hours of Service

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

9:00 – 6:00
9:00 – 6:00
9:00 – 6:00
9:00 – 6:00
9:00 – 6:00
9:00 – 4:30

Chiropractic hours break for lunch on Monday (1:00-3:00) and Wednesday (1:00-2:00).

Contact Us

3017 E Francis Ave, Suite 101
Spokane WA, 99208



Phone – (509) 467 – 7991

Fax – (509) 467 – 4834

frontdesk@spokanechiropractic.com

We've got your back!